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Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)


  • Marwân-al-Qays Bousmah

    (Aix-Marseille University)

  • Marie Libérée Nishimwe

    (Aix-Marseille University
    ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur)

  • Tamara Tovar-Sanchez

    (Institut de recherche pour le développement (IRD)-INSERM, and University Hospital of Montpellier)

  • Martial Lantche Wandji

    (Central Hospital of Yaoundé)

  • Mireille Mpoudi-Etame

    (Military Hospital)

  • Gwenaëlle Maradan

    (ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur)

  • Pierrette Omgba Bassega

    (Cité Verte Hospital)

  • Marie Varloteaux

    (Central Hospital of Yaoundé)

  • Alice Montoyo


  • Charles Kouanfack

    (Central Hospital of Yaoundé
    University of Dshang)

  • Eric Delaporte

    (Institut de recherche pour le développement (IRD)-INSERM, and University Hospital of Montpellier)

  • Sylvie Boyer

    (Aix-Marseille University)


Objectives Evidence comparing the economic and patient values of the World Health Organization’s preferred (dolutegravir 50 mg [DTG]-based) and alternative (low-dose [400 mg] efavirenz [EFV400]-based) first-line antiretroviral regimens is limited. We compared patient-reported outcomes (PROs), costs, and the cost-utility of DTG- versus EFV400-based regimens in treatment-naive HIV-1 adults in the randomised NAMSAL ANRS 12313 trial in Yaoundé, Cameroon. Methods We used clinical data, PROs, and health resource use data collected in the trial’s first 96 weeks (2016–2019). Quality-adjusted life-years (QALYs) were computed using utility scores obtained from the 12-item Short Form (SF-12) generic health scale. Other PROs included perceived symptoms, depression, anxiety, and stress. In the 96-week base-case analysis, we estimated the unadjusted and multivariate-adjusted (1) mean costs (in US$, 2016 values) and QALYs/patient, (2) incremental costs and QALYs/patient, and (3) net health benefit (NHB). Outcomes were extrapolated over 5 and 10 years. Uncertainty was assessed using the cost-effectiveness acceptability curve and scenario and cost-effective price threshold analyses. Results In the base-case analysis, the NHB (95% confidence interval) for the DTG-based regimen relative to the EFV400-based regimen was 0.056 (− 0.037 to 0.153), corresponding to an 88% probability of DTG being cost-effective. A 10% decrease in this regimen’s price (from $5.2 to $4.7/month) would increase its cost-effectiveness probability to 95%. When extrapolating outcomes over 5 and 10 years, the DTG-based regimen had a 100% probability of being cost-effective for a large range of cost-effectiveness thresholds. Conclusions At 2020 antiretroviral drug prices, a DTG-based first-line regimen should be preferred over an EFV400-based regimen in sub-Saharan Africa. Trial Registration Identifier: NCT02777229.

Suggested Citation

  • Marwân-al-Qays Bousmah & Marie Libérée Nishimwe & Tamara Tovar-Sanchez & Martial Lantche Wandji & Mireille Mpoudi-Etame & Gwenaëlle Maradan & Pierrette Omgba Bassega & Marie Varloteaux & Alice Montoyo, 2021. "Cost-Utility Analysis of a Dolutegravir-Based Versus Low-Dose Efavirenz-Based Regimen for the Initial Treatment of HIV-Infected Patients in Cameroon (NAMSAL ANRS 12313 Trial)," PharmacoEconomics, Springer, vol. 39(3), pages 331-343, March.
  • Handle: RePEc:spr:pharme:v:39:y:2021:i:3:d:10.1007_s40273-020-00987-3
    DOI: 10.1007/s40273-020-00987-3

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    References listed on IDEAS

    1. Glick, Henry A. & Doshi, Jalpa A. & Sonnad, Seema S. & Polsky, Daniel, 2014. "Economic Evaluation in Clinical Trials," OUP Catalogue, Oxford University Press, edition 2, number 9780199685028.
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    3. Beth Woods & Paul Revill & Mark Sculpher & Karl Claxton, 2015. "Country-level cost-effectiveness thresholds: initial estimates and the need for further research," Working Papers 109cherp, Centre for Health Economics, University of York.
    4. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    5. S. Boyer & M. L. Nishimwe & L. Sagaon-Teyssier & L. March & S. Koulla-Shiro & M.-Q. Bousmah & R. Toby & M. P. Mpoudi-Etame & N. F. Ngom Gueye & A. Sawadogo & C. Kouanfack & L. Ciaffi & B. Spire & E. D, 2020. "Cost-Effectiveness of Three Alternative Boosted Protease Inhibitor-Based Second-Line Regimens in HIV-Infected Patients in West and Central Africa," PharmacoEconomics - Open, Springer, vol. 4(1), pages 45-60, March.
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    Blog mentions

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    1. Journal round-up: PharmacoEconomics 39(3)
      by Chris Sampson in The Academic Health Economists' Blog on 2021-04-05 06:00:12

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